Pain physician
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Randomized Controlled Trial
Erector Spinae Plane Block Provided Comparable Analgesia as Thoracic Paravertebral Block Post Pediatric Nuss Procedure for Pectus Excavatum: A Randomized Controlled Trial.
Thoracic paravertebral block (TPVB) is frequently used to treat pain following a pediatric Nuss procedure but is associated with various undesirable risks. The erector spinae plane block (ESPB) also provides postoperative analgesia, which is purported to be easier to administer and has a favorable safety profile. However, it remains unknown whether ESPB provides analgesia comparable to the TPVB technique post pediatric Nuss procedure. ⋯ Preoperative ESPB, when combined with multimodal analgesia, was noninferior in analgesic effect compared with TPVB in terms of pain scores and opioid consumption in pediatric patients undergoing the Nuss procedure.
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Spinal cord stimulation (SCS) is often an option of last resort for patients with post-laminectomy syndrome or an alternative option for patients with complex regional pain syndrome, chronic nonsurgical low back pain, or painful diabetic peripheral neuropathy when conservative management has failed. Although SCS is a helpful option, it is not without complications that can frequently lead to explantation of the SCS device and dissatisfaction with the treatment. Furthermore, as with any technology, SCS has potential issues that may lead to patient frustration and ultimately result in patient noncompliance and lack of follow-up visits. ⋯ This paper, the first cross-sectional study of loss to follow-up among patients who are implanted with SCS devices, identifies that up to 19% of patients are quickly lost to follow-up after implantation. Only half of the patients in this study could be reached, with most successfully using their device for meaningful pain control, but a substantial number of patients likely required additional device optimization for pain relief.
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Review Meta Analysis Comparative Study
Comparison of Effectiveness of Intraarticular Hyaluronate and Corticosteroid injections in Adhesive Capsulitis: A Systematic Review and Meta-analysis.
Adhesive capsulitis of the shoulder causes inflammation and adhesions in the shoulder joint capsule, leading to pain and limited range of motion (ROM). Intraarticular corticosteroid (CS) and hyaluronic acid (HA) injections are common therapeutic options for adhesive capsulitis, but their comparative effectiveness remains unclear. ⋯ The administration of intraarticular HA injection emerges as a commendable therapeutic option for patients with adhesive capsulitis, particularly for those requiring repetitive injections or at risk of developing side effects from injections of CS. Although intraarticular CS injections offer accelerated short-term (2-4 weeks) pain relief and functional improvement, comparable effects were observed within 6 and 12 weeks after intraarticular HA and CS injections.
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Review Meta Analysis
The Analgesic Effectiveness of Genicular Nerve-targeted Cooled and Pulsed Radiofrequency Ablation for Osteoarthritis Knee Pain: A Systematic Review and Meta-analysis.
Radiofrequency ablation (RFA) is a form of therapy for knee osteoarthritis (OA) pain that has become more popular in recent years. In addition to standard RF approaches, there are cooled and pulsed options. RFA could be used to treat the superolateral, superomedial, and inferomedial branches of the genicular nerves. Pulsed and cooled RF ablation on the genicular nerve to treat knee OA pain, however, has not yet been shown to be effective. ⋯ At the 6-month follow-up, both cooled and pulsed RFA targeting the genicular nerve provided significant osteoarthritic pain alleviation. There is no different in pain relief between cooled and pulsed RFA targeting the genicular nerve for treating knee osteoarthritis. There was no significant functional improvement of cooled RFA in all follow-ups, but there was a significant functional improvement of pulsed RFA up to 3-month follow-up. According to our study, knee osteoarthritis pain can be efficiently treated with pulsed and cooled radiofrequency with few adverse effects.
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Prior research has suggested that the rhomboid intercostal block (RIB) may contribute to postoperative analgesia after surgeries of the chest and breast. ⋯ RIB may be a new option for pain relief after chest and breast surgery.